Electro Mapping & Ablation Update
So I survived Jan 18th, lol.
I must say survived is a good description, although as I reflect back on my experience one month later the drama of the procedure is softening a bit.
My day at the hospital started at 10am, no food or drink since 11pm the night before, which is fine. Two hours later I was still waiting as others came and went from the waiting room. Kingston had a big ice storm the day before so ER was full of slips and falls and thus was overflowing into the pre-op prep area. My sister was driving 3 hrs to be with me and had booked three days off work so I was really worried they would cancel my surgery. They didn't.
At 12:30pm I was herded (no better way to describe it) into a holding pen full of people. It was straight out of a movie when a major epidemic hits a city centre. I have never seen so many people crammed into one room. I nurse quickly gives me one little sheet and a gown and says everything off and change into this and lay here. I had to try and hold a curtain shut and strip with a window wide open to the other side of the hospital....hope they enjoyed the show, lol.
My other half was with me as my sis was still in transit and my girlfriend was at home with my daughter (good friends are such a gift). I lay there for about 20 min then a nurse, very friendly, came and put in my IV. She could tell I was nervous and stopped to chat for a few minutes to reassure me.
About 1:15pm I was wheeled up a couple floors to the next holding pen in the cardiac wing. IT was FULL....to the point there wasn't any room for me and I was shoved into a corner between two people, my bed sticking out. Two grumpy police officers were 1 1/2 beds over guarding somebody for some reason which left an air of tension in the room to say the least. It was very surreal.
After 10 min a lady doctor around 40 or so showed up at my bed and introduced herself as the doc who would be performing the surgery. She is what is called a Fellow, a graduated cardiologist who then goes on to do two more years of study to become a full electro physiologist in cardiology. Her bedside manner was excellent and she was confident and knowledgeable and answered all my questions without any eye-rolling or hesitations. I asked her if her back got sore doing all these surgeries and she said she didn't mind, it was fun. That was a good sign at least. During all that (and the signing of the "waiver") my sis showed up.
At around 1:45 they shooed my two family members out to the waiting room and off I went to the next station. Pierre was going home to relieve my girlfriend of baby duty and my sister would be staying during the procedure.
I was wheeled to a room which looked like another prep area. They asked me to get off the portable bed and walk into the room and sit on the bed in there. "Ok" I thought, must be another prep spot.
The room was like a big doctor's office with shelves of supplies and stuff, the cupboard doors open. Stacks of books and papers were on a desk at the back and beside that, chairs to sit in. At the front were two computers on a desk. Beside my bed was a big machine that looked like a mini CT scan device, heart monitoring equipment etc. I was observing all of this and then realized that they were putting all the leads on me and laying me down on the bed. I said, “THIS isn’t where you are doing the procedure is it?” They (4 nurses and the Fellow) laughed and said “YUP”. I couldn’t believe it. I asked if they did all the procedures in that room and they said yes, even the complicated ones. I asked the Fellow who is from Scotland if she found this odd when she arrived to do her training and she said yes but that the hospital had state of the art equipment so not to worry. As she was saying this a nurse walked in with a coffee. Nobody wore caps or masks, they did wear X-ray vests. I wasn’t getting the 3D mapping, though they have the capability, as it was only supposed to be a basic mapping and ablation, so I would get the X-ray. Great….LOTS of exposure.
First was the freezing for the catheter to be inserted under my collarbone. That pinched like getting your teeth done. Ok, it hurt I won’t lie. I was VERY nervous which didn’t help so I guess my shoulders were raised defensively. As it turns out my IV had a kink in it and the sedation never got to me so as the doc was digging around in my vein I could feel everything and it hurt. After team realized the issue and unkinked the line, the problem persisted. I had pain radiating down my arm and in my chest. After about 10 min the doc gave up and said my vein was collapsed due to dehydration. Heck, they had instructed me not to drink anything. So all the catheters would have to be inserted through my groin, a little crowded I guess.
I was still very nervous and tense (stiffer than a board). The groin insertion didn’t hurt but I felt each catheter go all the way up and they hit nerves on the way. I had shooting pains down my leg and in my butt and some up my back. I mentioned this and she (the doc) told me that the vein lies near nerves. I, of course, could feel and then report all of this because I think they were saving money on sedation, lol, as I certainly felt as alert as ever. I felt each catheter enter my heart and each time my heart felt a little “heavier”, like it was being compressed. I told them my observation and they told me I was fine, that my blood oxygen level was normal. After what seemed an eternity, all five catheters were in and then the doc did something that triggered what felt like my lower chambers vibrating. Then she did something else and my upper chambers (or that is what it felt like) did the same thing. While this was happening I felt a little short of breath but I kept my eyes on the blood O2 level.
While they were stimulating my heart that is when the attending physician entered and became part of the action. He stayed at the desk with the computers from that point on.
As it turned out my case wasn’t to be as simple as suspected. So what was supposed to be a simple mapping and ablation turned into a 4 hr mystery tour. They had to go to drugs to stimulate my heart even more to get a better picture. That was not fun. I liken it to being in the electric chair, though I know it is nothing that horrible. The problem was they couldn’t figure out all my issues as I have three different ones and they were all doing different things. So…they had to keep stimulating my heart..240 bpm.
This is hard to take for hours let me tell you; on top of that the nurses had a shift change in the middle of it as it was taking so long. Seriously! So a parade of nurses left and arrived (new coffees in hand). The second shift seemed to have little interest in my mental well-being and basically huddled in the back of the room unless called upon to add more drugs to the IV by the doc. By hour three I was so scared and exhausted. The doc came to me (my head) and told me they were having trouble pin pointing the exact problem but she thought they were getting close and I needed to hand on a little longer. I agreed but I started to cry, quietly. Not one nurse offered her hand or a kind word and all I wanted was to hold someone’s hand.
Finally, the doctor came to me and said they had determined the problem (I had been listening to them deliberate over this for hours so I sure hoped they had it right). It was AVNRT but it was unusual as the conduction went both directions as opposed to only one. The extra fibers were also close to the AV node so she warned me that there was a chance I could end up with a pacemaker. Then she asked if I wanted her to burn the site. YES YES YES just kill it please!
Finally…sedation! For the first time I got enough drugs to relax and I liken it to lying on a beach in the sun. At least that is what I convinced myself I was doing. They did 13 burns and I must admit I never felt any of them. I did feel as though I was at a football game though from all the encouragement and cheering coming from the attending physician as he called out to the doc doing the burns! They did have to bring me back a few times and stimulate my heart to see if they got it all and of course they had to go back in and burn some more..In the end…they said to me that they were very happy with the results and were 99% sure they got it!
The next thing I know the doc is pressing on my groin (I never felt the catheters coming out) and leads were being yanked off me. All of a sudden I was on the express tour out of the procedure room. I think because it was 5:30pm and everyone wanted to go home. Everyone disappeared and the next thing I knew I was wheeled into a ward with lots of other patients. Sometime later my sister showed up. Nobody had come out to tell her I was done and she was left sitting all alone in the waiting area with no clue what was going on.
The next part was not fun…the waiting for hours on your back so your groin doesn’t bleed. Before the procedure I was told I would be sedated to make the wait tolerable…NOT happening. The nurse told my sister that they don’t sedate people just so they can sleep. My back was killing me, right between the shoulder blades and my chest hurt. I was traumatized by the whole thing and in mental shock and completely distraught. I was happy it was over but I had had it. I needed to move and I couldn’t. For an hour I lay there complaining about sharp chest and back pain, right between the shoulder blades. I figured it was from having to lie in one position for so long, plus the fact that I had been so tense through the procedure but I started to wonder if I was having heart issues. Your mind tends to play games with you after years of unsolved heart problems. My sister went to fetch a nurse who came back with two Tylenol 2s which of course I had to swallow lying down. Considering the fact that I hadn’t consumed food or drink in 18 hrs, the pain medication didn’t sit very well in my stomach. Needless to say, 20 min later my sister was off fetching a bucket (no nurse in sight) and I threw up all the pain meds. That did not help the laying still so my groin wouldn’t bleed.
As I was in the process of throwing up, apparently the colour of white washed walls, the night-shift cardiologist came to see me. He took one look at me and ordered a chest X-ray and echo to make sure there hadn’t been any complications post procedure. He told me that I had a very complicated procedure for somebody who was supposed to have a simple ablation but that he was positive the team had fixed the problem. The doctor was kind and took his time telling me what to expect including possible fluttering that would feel like the start of arrhythmia but that wouldn’t amount to anything. The team had said that I wouldn’t know for sure for at least 2-3 months whether the procedure had worked or not.
After two and a half hours they let me sit up in bed, I think because I was complaining so much of back pain. Immediately I started to feel better. I am not a back sleeper by nature so spending that much time flat on my back was just too much for me. They took a chest X-ray (great even more exposure, lol) and did an echo at my beside and everything showed clear which also put my restless mind at ease. After another 3 hrs they finally let me leave.
I must say the team of doctors were very good but the nursing staff seemed very absent. I find that unusual as it is mostly the nurses who normally help to make you feel calm and safe.
That night, at home, I slept restlessly but without arrhythmia. My heart rate was faster but even. In the morning I felt as though I had been hit by a truck or had run a marathon. It is hard to explain except I felt “heart” exhausted. I also started to sport a pretty mean headache that all the Tylenol in the world couldn’t seem to ease. My sister was a great help with my 22 month old, so I mostly sat and rested. My groin was sore, nothing like a C-section, but tender to say the least as was my collarbone.
Day two post surgery and I had such a bad headache I thought maybe I had a blood clot somewhere. I visited my family doc who determined that all appeared to be functioning normally. As it turns out it must have been dehydration and stress because I made a point of getting as much fluids as possible into me. By the end of the day my headache had turned down to background pain. I did go grocery shopping with my daughter and my sister but I discovered that pushing the cart through the snow and in the store was too much for me as I started to get a few chest pains and felt very fatigued.
I took it easy for about 7 days and then started back with long brisk walks. I was very curious to see whether the arrhythmias would come back. To my joyous relief, no arrhythmias, even at a brisk long walk. I did get stabbing chest pains that lasted for about 10 minutes which bothered me. I was thinking, “Darn, now the chest pains are back”.
So here I am today a little over a month since my procedure and I must say I am thrilled with the results so far! I did have those stabbing chest pains on and off for about a week after the procedure and they still come very infrequently. I found when I first started to up the workouts my heart rate would elevate quickly, yet without turning to arrhythmia. My doctor told me that often after an ablation the heart becomes “sensitive” and will beat faster upon request of work. I am happy to say that I am back playing competitive volleyball twice a week without incident thus far. I am back doing kick boxing workouts (30-40 min) a couple times a week and going for a few long brisk walks a week. Sometimes if I really get going on the V-ball court I get a “tight” feeling in my heart so I slow it down a bit. I think I need to let it get fit again.
Just in the last couple of nights I had a SEVERE case of food poisoning with violent vomiting etc and that would have spelled disaster with my arrhythmia before. Not one beat out of place even though I became terribly dehydrated.
I am cautious to say that it worked for sure but it is looking good for me so far.
All in all, It was a very stressful and yes, scary procedure for me as I tend to be a bit high strung to begin with but I am thoroughly thankful that I decided to go ahead to do it. I feel that I am slowly letting go of some of the “heart” anxiety I have lived with for so long. I do still have two problems electrically they could not fix at that time. One is extra bundles of cells that cause extra beats in the atrium and the other is the AV node problem of dropped beats. Since the ablation I have only noticed dropped beats twice and the extra beats I have only noticed a couple of times also. Now that I know neither problem is life-threatening I don’t sweat the “small” stuff anymore. I can live with the very occasional extra beat or missed beat in comparison to the completely horrible AVNRT!
As for unexplained chest pain….that is the next frontier.